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Issue 209 | Oct. 9, 2015 | Focus on Global Handwashing Day 2015

Global Handwashing Day occurs each year on October 15. It is a global advocacy day dedicated to increasing awareness and understanding about the importance of handwashing with soap as an effective and affordable way to prevent diseases and save lives. This issue contains links to handwashing resources from WASHplus, the Global­Public­Private Partnership for Handwashing, recent studies, reports, and videos.

RESOURCES

Global Public­Private Partnership for Handwashing (PPPHW) This coalition of international stakeholders works explicitly to promote handwashing with soap and recognize hygiene as a pillar of international development and public health. Just a few of the partnership’s resources include the PPPHW website with links to webinars, fact sheets, and member organizations. Also the Global Handwashing Day Social Media Toolkit features sample messages, blog ideas, and resources to help celebrants and handwashing champions spread the word about Global Handwashing Day.

WASHplus RESOURCES

Small Doable Actions: A Feasible Approach to Behavior Change Learning Brief, 2015. Link A small doable action is a behavior that, when practiced consistently and correctly, will lead to personal and public health improvement. It is considered feasible by the householder, from HIS/HER point of view, considering the current practice, the available resources, and the particular social context. This brief takes a look at how WASHplus has applied this approach to a range of activities—handwashing, water treatment, improved sanitation, menstrual hygiene management, and food hygiene.

Handwashing and the Science of Habit, 2014. Webinar This webinar features panelists David Neal, Catalyst Behavioral Sciences; The University of Miami; Jelena Vujcic, Catalyst Behavioral Sciences; The University of Buffalo; Orlando Hernandez, WASHplus, FHI360 and Wendy Wood, The University of Southern California.

Integrating Safe Water, Sanitation, and Hygiene into Infant and Child Nutrition Programmes: A Training and Resource Pack for Uganda, 2014. Link The overall objective of this resource pack is to facilitate the training of village health teams, community knowledge workers, peer support groups, and other outreach workers on how they can help household and community members to overcome, or change, the many daily obstacles to improved water, sanitation, and hygiene (WASH) practices in the home.

Integrating Safe Water, Sanitation, and Hygiene into HIV Programmes: A Training and Resource Pack for Uganda, 2014. Link This training manual teaches the four key WASH practices, including: safely transporting, treating, storing, and serving drinking water; safe handling and disposal of feces; safe handling and disposal of menstrual blood; and handwashing with soap (or ash) and water, and demonstrates actions required to implement the WASH practices.

How to Make Other Types of Tippy Taps, 2014. Link This pamphlet shows how to make Tippy Taps from mineral water bottles, tin cans, and hollow tubes.

EVENTS

October 21, 2015 – What the "H" Is the Big Deal with Hygiene? Registration Link FHI 360 and PPPHW will host an event Wednesday, October 21, 2015, from 4:30– 7 p.m. (EDT) in Washington, DC. Learn why the “H” in hygiene should be silent no longer. Hygiene experts will discuss the importance of handwashing and hygiene and the Sustainable Development Goals.

September 25, 2015 – Creativity in Behaviour Change: A Day of Learning, Sharing and Creating as Part of London School of Hygiene & Tropical Medicine’s Annual Symposium. Link to presentations and videos This event featured interactive sessions and presentations that explored what behavior change is and why creativity is an important ingredient in the process. Behavior change theories and approaches that have developed over several decades were discussed.

RECENT ARTICLES AND REPORTS

Level of Behaviour Change Achievable by Handwashing with Soap Interventions: A Rapid Review, 2015. M Heijnen. Link This report outlines key factors that may contribute toward a successful behavior change intervention, such as extensive formative research to understand the target population, duration of follow up (as well as number of follow­up points) after intervention, baseline levels of handwashing behavior, and the key handwashing times that are targeted. Overall, this area of research would benefit from rigorous impact and process evaluation, subsequent modification of intervention design, and further testing of “new generation” handwashing with soap interventions. In addition, evidence of cost would be beneficial, as this would help determine which successful interventions can also be implemented in a cost­effective manner.

Children as Handwashing Change Agents: A Short Review of the Evidence, 2015. PPPHW. Link Many global health behavior change programs focus on influencing children, given their adaptability. In the early years of life, children are still learning about the world, identifying social norms, and forming lifelong habits, so this is an opportune moment to help them develop the habit of handwashing with soap at critical times. But can children be more than the passive recipients of knowledge, values, beliefs, and behaviors? A growing body of thought supports the concept of respecting and valuing children as health­promoting actors for their families and peers.

Global, Regional, and National Comparative Risk Assessment of 79 Behavioural, Environmental and Occupational, and Metabolic Risks or Clusters of Risks in 188 Countries, 1990–2013: A Systematic Analysis for the Global Burden of Disease Study 2013. The Lancet, Sept 2015. Global Burden of Disease 2013 Risk Factors Collaborators. Link Six new risk factors have been added since the 2010 study: handwashing practices, occupational exposure to trichloroethylene, childhood wasting, childhood stunting, unsafe sex, and low glomerular filtration rate. In sub­Saharan Africa, the leading risk factors are child and maternal malnutrition, unsafe sex, and unsafe water, sanitation, and handwashing. Behavioral, environmental and occupational, and metabolic risks can explain half of global mortality and more than one­third of global disability adjusted life years, providing many opportunities for prevention.

Over­Reporting in Handwashing Self­Reports: Potential Explanatory Factors and Alternative Measurements. PLoS One, Aug 2015. N Contzen. Link Although the difficulties involved in measuring handwashing by self­reports and observations are widely known, the present study is the first to investigate the factors that explain over­ reporting of handwashing. This research contributes to the limited evidence base on a highly important subject: how to evaluate handwashing interventions efficiently and accurately.

Efficacy of Handwashing with Soap and Nail Clipping on Intestinal Parasitic Infections in School­Aged Children: A Factorial Cluster Randomized Controlled Trial. PLoS Med, June 2015. M Mahmud. Link Handwashing with soap at key times and weekly nail clipping significantly decreased intestinal parasite reinfection rates. Furthermore, the handwashing intervention significantly reduced anemia prevalence in children. The next essential step should be implementing pragmatic studies and developing more effective approaches to promote and implement handwashing with soap and nail clipping at larger scales.

Testing Disgust­ and Shame­Based Safe Water and Handwashing Promotion in Urban Dhaka, Bangladesh, 2015. R Guiteras. Link The chlorine dispenser is not popular in Dhaka, though a niche market may exist for a small share of compounds. The soapy bottle, in contrast, has very low cost and holds promise for increasing handwashing in other settings where households share water sources or latrines.

Impact of Intensive Handwashing Promotion on Secondary Household Influenza­ Like Illness in Rural Bangladesh: Findings from a Randomized Controlled Trial. PLoS One, June 2015. P Ram. Link Handwashing promotion initiated after illness onset in a household member did not protect against influenza­like illness or influenza. Behavior may not have changed rapidly enough to curb transmission between household members. A reactive approach to reduce household influenza transmission through handwashing promotion may be ineffective in the context of rural Bangladesh.

Handwashing Promotion in Humanitarian Emergencies: Strategies and Challenges According to Experts. Jnl Water Sanitation Hygiene for Dev, Sept 2015. J Vujcic. Abstract Diarrhea and acute respiratory infections account for nearly 30 percent of deaths among children displaced by humanitarian emergencies. Handwashing with soap reduces the risk of contracting these diseases in nonemergency settings. However, the practice and the effectiveness of handwashing promotion efforts and the health benefits are not well documented in emergency settings. The authors identified many constraints to implementing effective handwashing promotion efforts, including a failure to define objectives and targets for improvements in handwashing rates; lack of technical expertise and attention to the development and implementation of effective behavior change communication approaches; and limited understanding of the appropriateness, use, and acceptability of different handwashing hardware.

Social­Cognitive Factors Mediating Intervention Effects on Handwashing: A Longitudinal Study. J Behav Med. Aug 2015. N Contzen. Abstract The present article investigates the underlying change processes of theory­based handwashing interventions. A non­randomized field study compared a standard approach to two theory­based interventions that were tailored to the target population—the inhabitants of four villages in southern Ethiopia. In comparison to the standard approach (i.e., education only), education with public commitment and reminder was slightly more effective in changing social­cognitive factors and handwashing. Education with infrastructure promotion and reminder was most effective in promoting handwashing. The results confirm the relevance of testing interventions’ underlying change processes.

Identifying the Psychological Determinants of Handwashing: Results from Two Cross­Sectional Questionnaire Studies in Haiti and Ethiopia. Am J Infect Control, Aug 2015. N Contzen. Abstract Diarrheal disease kills around 760,000 infants every year. Many of these deaths could have been prevented by handwashing with soap. However, the whole range of psychological factors encouraging handwashing is not yet identified, and handwashing campaigns are often limited to awareness­raising and education. The purpose of this article was to identify the psychological determinants of handwashing in Haiti (study 1) and Ethiopia (study 2).

Observed Practices and Perceived Advantages of Different Hand Cleansing Agents in Rural Bangladesh: Ash, Soil, and Soap. Am J Trop Med Hyg, June 2015. F Nizame. Abstract Bangladeshi communities have historically used ash and soil as handwashing agents. Field workers observed people using ash/soil to wash their hand(s) on 13 percent of occasions after defecation and on 10 percent after cleaning a child’s anus. This compares with 19 percent of people who used soap after defecation and 27 percent after cleaning a child who defecated. Most informants reported that ash/soil was used only for handwashing after fecal contact, and that ash/soil could clean hands as effectively as soap.

PPPHW Handwashing Research Summary, January – March 2015. Link This research summary reviews the relevant peer­reviewed studies published in the first quarter of 2015.

PPPHW Handwashing Research Summary, April – June 2015. Link Between April and June 2015, 17 relevant peer­reviewed handwashing studies were identified.

BIBLIOGRAPHIC DATABASES Programme Solidarite Eau (PSEAU). Website

List of English Tools on Handwashing. Link List of French Tools on Handwashing. Link

VIDEOS

How a TV Spot in India Highlights the Importance of Handwashing Before Handling Food, 2015. BBC Media. Video Everybody knows the importance of washing hands before touching food. But nobody remembers it at that exact moment. Nor that handwashing is incomplete without soap. To convey this message, a mother had to turn into a villain.

Hand Washing Song – Return Challenge Uganda, 2015. Video Nyamabuga NEEP (Nations Efforts to Eradicate Poverty) Jr. Ambassadors respond to the California NEEP Jr Ambassadors. Now we challenge YOU to learn the handwashing song. Learn the song and send us your response. Join the NEEP Jr. Hand Washing Challenge! Don't forget the soap!

Handwashing Song, Gambella, Ethiopia, 2015. OXFAM. Video. Refugee men and women who work as hygiene promoters demonstrate safe handwashing through song.

WASHplus Weeklies highlight topics such as Urban WASH, Household Air Pollution, Innovation, Household Water Treatment and Storage, Handwashing, Integration, and more. If you would like to feature your organization's materials in upcoming issues, please send them to Dan Campbell, WASHplus Knowledge Resources Specialist, at [email protected].

About WASHplus ­ WASHplus, a multi­year project funded through USAID’s Bureau for Global Health, supports healthy households and communities by creating and delivering interventions that lead to improvements in access, practice and health outcomes related to water, sanitation, hygiene (WASH) and household air pollution (HAP). WASHplus uses at­scale, targeted as well as integrated approaches to reduce diarrheal diseases and acute respiratory infections, the two top killers of children under five years of age globally. For information, visit www.washplus.org or email: [email protected].